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BANA Outpatient Story
BANA Admin
2026-02-17T11:51:20-05:00
BANA Story Form
How has your ED journey been going? Do you have a story you want to share with our team?
1. Could you share what stage of treatment you are currently in?
In Treatment
Completed Treatment
Withdrawn from Treatment
2. I wanted the team at BANA to know....
3. Your story is incredibly valuable. We sometimes use anonymous or attributed quotes from clients/service recipients in reports or media campaigns. Do you consent to have your written feedback and/or comments from this form being used ?
Yes
No
4. If you answered "Yes" to the question above, please indicate how you would allow your feedback to be used in a testimonial:
I consent to my feedback being used and attributed with my name (e.g., "Jane D. Smith, Attendee")
I consent to my feedback being used anonymously (e.g., "A presentation attendee")
4.1. If you would like to be attributed, please provide your Name (Optional):
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